Parkinson’s Disease: - PowerPoint Presentation

Slide1

Parkinson’s Disease:Think BIG!

Tasha KelschSlide2

Objectives:

Define Parkinson’s Disease (PD)Discuss the epidemiology and etiology of PDList the characteristics associated with PDDevelop an understanding of LSVT Big therapyList the benefits of LSVT Big for people w/ PDInterpret research studies related to LSVT BigRecognize BIG exercises

Slide3

Define Parkinson’s Disease (PD):

A chronic degenerative and progressive disease of the nervous system associated with a decreased production of dopamine in the substantia niagra. Slide4

Facts about PD:

PD affects more than 2 percent of the population older than 65 years of age.Average age of onset is 50-60 years.Men and women are affected equally.PD produces abnormalities of basal ganglia functionThere are two types: -Idiopathic - Secondary Parkinsonism

There are two distinct clinical subgroups:

-Postural instability and gait disturbed

-Tremor predominant

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Clinical characteristics

Bradykinesia, hypokinesia, and freezingTremorPostural InstabilityPoor balanceMotor planning deficitsMotor learning deficitsGait disturbancesSensation deficitsSpeech, voice, and swallowing disorders

Decreased cognitive function

Behavior problems

Autonomic nervous system dysfunction

Cardiopulmonary dysfunction

Fatigue

DepressionSlide6

LSVT (Lee Silverman Voice Treatment)

LSVT programs have been developed and researched over the past 20 years and began with a focus on speech (LSVT Loud).The LSVT program has recently extended to include motor systems of the limbs (LSVT Big) LSVT Programs include:-Increased amplitude (Loud speech and bigger limb movements)-A focus on sensory recalibration:

T

he

brain’s automatic correcting of errors in our sensory or perceptual systems

-Training self-cuing and attention to actionSlide7

LSVT

Neuroplasticity is defined as the capacity of nerve cells in the brain to modify their activity in response to environmental stimulation.LSVT programs promote neuroplasticity including:-Specificity, targeting bradykinesia and hypokinesia

through increasing amplitude of motor

output

-

I

ntensity

, increased dosage of

treatment

-

R

epetition

, increased repetition of tasks (minimum 15 repetitions) within treatment sessions and home

practice

ADL’s: The motor

exercises

are directly translated into

functional daily

activities.Slide8

LSVT Big

Delivered 1:1 w/ intensive motivation and feedback. “How big does that feel?” High intensity: Patients are encouraged to work w/ at least 80% of maximal energy on every repetition. 50% of the exercises consist of standardized whole-body movements w/ max amplitude, repetitive multidirectional movements, and stretching. The other 50% of exercises include goal-oriented activities of daily living. ADL’s are performed using high-amplitude movements with intensive motivation and feedback.

The

goal of training BIG is to teach patients to use bigger movements in routine activities to provide sustained training in everyday movements

.

BIG therapy can also benefit patients with other conditions including stroke, Multiple Sclerosis, and cerebral palsy.Slide9

Benefits of LSVT BIG:

Improves standing balanceIncreases trunk rotationImproves ability to reach furtherIncreases speed and step length in gaitImproves postureImproves body awarenessReduces falls

Increases ROM in jointsSlide10

ResearchComparing Exercise in Parkinson’s Disease:The Berlin LSVT BIG Study. -

Movement Disorders Vol. 25 No. 12, 2010Training BIG to move faster: The application of the speed-amplitude relation as a rehabilitation strategy for people with Parkinson’s disease. – Experimental Brain Research Vol 167 December 2005Slide11

Research Article:

Comparing Exercise in Parkinson’s Disease:The Berlin LSVT BIG Study. Subjects: 60 patients with mild to moderate PD Methods: Patients were randomly assigned to receive either one-to-one training (BIG), group training of nordic walking (WALK), or unsupervised home exercises (HOME).

Each group

was assigned to a specific training program and

was reassessed after 16 weeks. The

primary efficacy of measure was the Unified Parkinson’s Disease

R

ating Scale (UPDRS-III) score between

tx

groups after week 16. Secondary outcome variables included differences in quality of life (PDQ-39), Timed up and Go (TUG), and

10 meter walk test.

All tests were performed w/ medications. Slide12

Results:

LSVT BIG led to improved motor performance in patients w/ PD. UPDRS motor scores improved in the BIG group but had not improved in the WALK or HOME groups. The BIG group was also superior in TUG and 10 m walking. There were no significant group differences in quality of life (PDQ-39)Slide13

Research Article: Training BIG to move faster: The application of the speed-amplitude relation as a rehabilitation strategy for people with Parkinson’s disease.

Subjects: 18 volunteers w/ PD w/ no medical complications that would interfere with limb movement. The subjects had to be stable on medications w/ no other neurological diagnosis and had never participated in LSVT. Methods: All of the subjects received 16 individual one hour BIG therapy sessions for 4 weeks. The subjects were tested one week before and one week after. Gait analysis was performed on a 14 ft electronic mat that measured velocity, cadence and stride length. Reaching was measured and videotaped. The subjects performed

multijoint

reaching at different distances. Wrist velocity was measured by a Butterworth filter

.Slide14

Results: The subjects with PD increased both gait velocity and stride length after training BIG. Reaching velocity increased for the longest distances. Slide15

Rolling

Begin face up in bed or on a mat table w/ both arms flexed to 90°, palms touching.

Drop

one arm all the way out to the side. Roll towards, reaching with opposite

arm as

far as you are able. Repeat _____times.Slide16

Sitting

Begin sitting in a chair with palms in lap. Reach arms as far forward as you can

.

Then

reach towards the floor.

Next

reach as high above you as you can.

Last,

bring

arms down to reach as

far behind

you as you can. Bring palms back to

lap

and

repeat_____times

.Slide17

Sit to Stand

Lean forward with both feet underneath you. Push up from where you are sitting to stand up. As you come to a stand reach up with your arms as high as you can. Repeat _____times. Slide18

Standing/Weight Shifting

Begin with both feet flat on ground. Take a BIG step forward with right foot so that legs are

scissored

and spread far apart. Alternate swinging arms as high as you can with right arm

foward

while shifting your weight onto right foot to lift left heel. Shift your weight back onto left foot to lift right toes off ground while swinging left arm forward and right arm back. Repeat _____times, and then repeat with left foot forward. Slide19

Standing/Stepping

Begin standing with feet shoulder width apart. Take a BIG step forward with right leg while spreading arms apart wide and behind you to open up chest. Bring right foot back to starting point and palms to front of thighs, then step with the left w/ same arm movement. Alternate stepping _____times. Slide20

Sitting Trunk Rotation

Begin sitting with palms in lap, knees bent w/ feet flat on floor and legs spread open. Reach arm as far to the right as you can to rotate trunk. Keep arm flexed to 90°. Next rotate trunk to the left to reach with right arm to the opposite side. Slide right foot outward as you turn so that you may reach further. Bring palms back to thighs then repeat

with

left arm. Repeat _____times. This exercise may

also be

performed in

standing.Slide21

Standing Trunk Rotation

Standing with feet wide apart and arms spread apart to open chest. Rotate trunk to reach right arm far to the left while bringing left arm far behind. Repeat to reach with left arm. Alternate arms to rotate trunk left and right.Slide22

Ambulation

Take Big steps forward to walk while swinging arms as BIG as you can. Bring opposite arm and leg forward at the same time. Walk BIG for _____minutes. Slide23

References:

Ehab G, Barsnley S, Chellappa R. Effect of physical exercise-movement strategies programme on mobility, falls, and quality of life in Parkinson's disease. International Journal Of Therapy & Rehabilitation [serial online]. February 2012;19(2):88-96. Available from: Academic Search Premier, Ipswich, MA. Accessed November 23, 2012

Farley

B,

Koshland

G. Training Big to move faster:

The application of the speed-amplitude relation as a rehabilitation strategy for people with Parkinson’s Disease.

Experimental Brain Research. Dec 2005;

Vol

167.

Movement Disorders Clinic. Comparing

Exercise in Parkinson’s Disease-The Berlin LSVT Big Study.

Movement Disorders. 2010; Vol. 25, No. 12 pp. 1902-1908

.

O’Sullivan S, Schmitz T. Physical Rehabilitation 5

th

Edition. Philadelphia: F.A. Davis Company; 2007.

www.lsvtglobal.com

http://www.hindawi.com/journals/pd/2012/391946

/

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www.youtube.com/watch?v=3jPEtanYmI0&feature=related

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